Provider Demographics
NPI:1497759286
Name:FRASER, ASAD (MD)
Entity type:Individual
Prefix:DR
First Name:ASAD
Middle Name:
Last Name:FRASER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1708
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:
Practice Address - Street 1:2724 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4000
Practice Address - Country:US
Practice Address - Phone:270-783-3338
Practice Address - Fax:270-780-0468
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29921207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64299217Medicaid
KY000000044712OtherANTHEM
KY64299217Medicaid
KY50003578OtherPASSPORT
KY1537012Medicare PIN
KY50003578OtherPASSPORT
KY000000044712OtherANTHEM
KY64299217Medicaid